摘要
目的:比较晚期肺癌(ⅢB期及Ⅳ期)患者化疗前、后肺部感染菌谱分布特点及其对抗生素敏感性的变化,探索多周期(≥4)化疗患者的最佳抗生素使用方案。方法:采集本院2005年1月～2007年5月住院治疗的181例晚期非小细胞肺癌合并肺部感染患者化疗前、后痰标本共309例次进行病原菌培养,并作20种常用抗生素药敏试验,对结果进行统计学分析。结果:化疗前痰标本145例次、化疗后164例次。阳性菌株(依常见程度)化疗前、后均为白色念珠菌、阴沟肠杆菌、粘膜炎布兰汉菌、鲍曼不动杆菌、肺炎克雷伯杆菌,无统计学差异(Z=-0.005,P=0.996)。化疗前、后主要敏感抗生素为氟康唑、伊曲康唑、头孢哌酮/舒巴坦、头孢他啶等,其敏感性变化无统计学差异(P>0.05)。但氨苄西林、亚胺培南、氨曲南、头孢克罗、左旋氧氟沙星化疗后耐药性有所增加(P<0.05),而头孢唑啉与头孢西丁化疗后耐药性降低(P<0.05)。结论:1)晚期肺癌患者化疗前肺部真菌感染率较以前报道升高;2)晚期肺癌患者化疗前、后肺部感染病菌谱变化不明显;3)化疗对各主要敏感抗生素敏感性影响不大;4)晚期肺癌患者多周期化疗后引起部分抗生素耐药性增加,主要集中在二代头孢菌素类及青霉素类抗生素。
Objective： To analyze the pathogenic bacterial distrihution and drug-resistance before and after chemotherapy in advanced hmg cancer patients wilh respiratory, infections. Methods： Sputum specimens were collected from advanced lung cancer patients with respiratory infections between January 2005 and May 2007. Bacterial culture and antihiolic sensitivity tests were performed. Results： A total of 309 specimens were collected with 145 taken before chemotherapy and 164 taken after chemotherapy （≥4 cycles）. The most commonly detected strains were C.albicans, A.cloaeae, B.catarrhalis, A.baumanii and K. pneumoniae. No signifieant difference was found in haeterial spectrum between the pro-chemotherapy specimens and the post-chemotherapy specimens（P〉0.05）. The following antibioties were effective before and after chemotherapy： Flueonazole, ltraconazole, Cefoperazone/sulbactam and Ceftazidime, with no changes in sensitivity（P〉0.05）. Resistance to Ampieillin, hnipenem, Aztreonam, Cefaclor and Levofloxacin increased after chemotherapy （P〈0.05）. The resislanee to Cefuxitin and Cefazolin decreased after chemntherapy（P〈0.05）. Conclusion： The species of the predominant strains of microbes present in respiratory infections in advanced lung cancer patients were different from those found in other types of patients. Gram-negative bacteria and fungi dominate the spectrum, and the fungal infeetion rate is higher in advanced lung cancer patients than in other patients. Chemotherapy has no major influence on the effect of antibiotics, but several antibiotics, most of which are biobasic-eephalosporins and penicillins, have decreased efficacy in patients with muhicyele chemotherapy.
出处
《中国肿瘤临床》
CAS
CSCD
北大核心
2008年第8期428-430,434,共4页
Chinese Journal of Clinical Oncology
基金
吴阶平基金会临床科研专项基金资助(编号:04101002)
关键词
肺癌
感染
抗生素
耐药
Lung cancer
Infection
Antibiotic
Drug resistance
